Provider Demographics
NPI:1770911273
Name:CHRISOPOULOS, FOTINI (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:FOTINI
Middle Name:
Last Name:CHRISOPOULOS
Suffix:
Gender:
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 CORNERSIDE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:TYSONS
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2440
Mailing Address - Country:US
Mailing Address - Phone:703-625-6229
Mailing Address - Fax:
Practice Address - Street 1:1500 CORNERSIDE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:TYSONS
Practice Address - State:VA
Practice Address - Zip Code:22182-2440
Practice Address - Country:US
Practice Address - Phone:703-625-6229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-18
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014142381223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics